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Home Telehealth Scoping Review

A synthesis of current evidence base in telehealth and identification of priority research questions

Principal Investigator: Sandra Jervis-Selinger, Joanna Bates The home telehealth scoping review provides a representative picture of home-based chronic care telehealth, identifying key gaps and priority research questions pertaining to BCATPR’s three priority themes. With the support of BCATPR members, a scoping search strategy was developed by the research team. After titles and abstracts were scanned for relevance, 51 articles or reports were included in the review. The review demonstrates that the research on home-based telehealth applications is far from comprehensive, particularly in the Canadian context. A multitude of significant issues remain unaddressed in each of the priority themes. Nevertheless, the research questions elucidated by this review outline important research gaps and elucidate possible avenues for future research on homebased telehealth applications.

Background

Telehealth has been increasingly utilized in Canada to improve patient access to health services despite geographical, cultural and socio-economical barriers. Telehealth can be applied to a variety of settings, including hospitals, clinics, ambulances and prisons, but the most prevalent and promising location for telehealth is in the patient’s home (Meystre, 2005). Indeed, provision of care directly to the patient’s home has the potential to prevent hospitalization, reduce health care costs and provide an alternative to conventional hospital outpatient or health professional visits. Although telehealth services at large have been employed in various capacities for several years, home-based telehealth applications are still relatively new to the healthcare system (Koch, 2005). Yet, as the burden of chronic illnesses on the Canadian healthcare system grows and the scarcity of health human resources in rural and remote regions intensifies, home-based telehealth applications have increasingly been identified as a possible mitigating factor, as well as a potentially effective way to treat and rehabilitate patients with chronic diseases (Hebert, Korabek, & Scott, 2006; Schaafsma et al., 2007; Liddy et al., 2008; Pare, Jaana, & Sicotte, 2007).

Methodology

With the support of BCATPR members, a scoping search strategy was developed by the research team. Published peer-reviewed literature pertaining to home-based chronic care telehealth was identified via a systematic search of the following databases: Medline, EMBASE, CINAHL, and Web of Science. The Journal of Telemedicine and Telecare was hand searched due to its particular relevance to this scoping review. In addition, grey literature was surveyed and found through Google Scholar and the websites of the Provincial Health Services Authority, the Canadian Society of Telehealth, and Canada Health Infoway. All articles and reports were restricted to include only those written in the English language and published between the years of 2003 and 2008. The initial search yielded 583 peer-reviewed articles from the databases, 36 peer-reviewed articles from the Journal of Telemedicine and Telecare and 7 articles and reports from the grey literature. In total, 626 sources were found using the initial search criteria. Following the structure of a scoping review strategy, the initial search results were further restricted to peer-reviewed and grey literature that met one of the following inclusion criteria: 1) meta-analyses; 2) review articles; 3) randomized control trials; 4) Canadian articles or reports; and 5) articles of direct relevance to Canadian home-based telehealth that nonetheless did not fit the previous four search parameters (ie. grey literature). After titles and abstracts were scanned for relevance, 51 articles or reports were included.

Results

Compared to other nations, Canada lags behind in publications on telehealth. This is despite the establishment of home-based telehealth as a national priority (Koch, 2007). Patient Theme Despite the growing availability of telehealth technology infrastructure, telehealth utilization in Canada remains limited in many home and community settings. Although accounts of patients’ actual uptake and use of telehealth services are sparse in the literature, the impact of home-based telehealth applications on patients attitudinal effects are frequently discussed, providing insight into patient willingness to use home-based telehealth applications. Self-management regimens are rarely discussed in the literature on home-based chronic care telehealth interventions. Yet, the evidence presented suggests that home-based telehealth applications can positively affect self-management for patients with heart failure, diabetes, hypertension or wounds. The impact of home-based telehealth applications on clinical outcomes is frequently evaluated in the literature. The most effective home-based telehealth applications to date are monitoring of vital signs and telephone follow-up by nurses for patients with chronic diseases. However, Canadian organizations providing telehealth services to patients – including those in the home setting - rarely perform comprehensive evaluations of telehealth applications. Indeed, only 46% of organizations either actively collected or were developing a collection process for clinical outcomes and cost-analysis data. Provider Theme Home-telehealth systems appear to enhance provider-patient communication and provide closer health monitoring compared to face-to-face consultations. Physicians reported that information derived from home-based telehealth applications is helpful in assisting with patient monitoring and assessing patient stability. However, information on provider uptake of telemonitoring technologies is rare. Most studies on telemonitoring focus on clinical and behavioural outcomes/changes, and not on provider perceptions or uptake. Policy Theme The literature is relatively sparse in terms of detailing specific policies on home-based telehealth. Where policy is discussed, the literature tends to focus on national or provincial level telehealth policies for service delivery in clinics and hospitals. Above all, critiques of current telehealth care policy – or the lack thereof – dominate the literature.

Conclusion

Although the literature on telehealth is vast and in a consistent state of growth, this scoping review has demonstrated that the research on home-based telehealth applications is far from comprehensive, particularly in the Canadian context. Certainly, the evaluated literature has provided a variety of determinants which influence the success of home-based telehealth applications. Yet, in all three of the categories outlined – patient, provider and policy – a multitude of significant questions remain unanswered. The priority research questions conceived from the gaps identified in this review are expected to stimulate further avenues for research on home-based telehealth applications.

Click here to view the briefing notes for the Home Telehealth Scoping Review study.